# NORTHEASTERN DENTISTRY @ OVERBROOK

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699073239
- **Authorized official:** DR. KAVITHA CHADHALAVADA DDS (OWNER DENTIST)
- **Authorized official phone:** (856) 325-0560

## Contact information

- **Practice address:** 6554 LEBANON AVE, PHILADELPHIA, PA 19151-3328
- **Practice address phone:** (215) 878-0058
- **Practice address fax:** (877) 707-5571
- **Mailing address:** 6554 LEBANON AVE, PHILADELPHIA, PA 19151-3328
- **Mailing address phone:** (215) 878-0058
- **Mailing address fax:** (877) 707-5571

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 03/07/2011
- **Last updated:** 09/30/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1020256650007 | — | PA |